Acute Mountain Sickness in Physically Active Individuals: The Role of Fitness, Acclimatization and Symptom Monitoring in Preparation for Mountain Exercise - A Narrative Review
DOI:
https://doi.org/10.12775/QS.2026.63.73057Keywords
acute mountain sickness, altitude illness, athletes, mountain exercise, acclimatization, Lake Louise Score, hydration, high-altitude trainingAbstract
Background. Mountain exercise, trekking, skiing and altitude training expose physically active individuals to hypobaric hypoxia and acute altitude illness. AMS usually occurs after rapid ascent above approximately 2500 m and may impair safety and performance.
Aim. This narrative review summarizes evidence on AMS in physically active individuals, focusing on fitness, ascent profile, acclimatization, load management, hydration, nutrition, symptom monitoring and anti-doping issues.
Material and methods. A PubMed-based narrative search was performed in May 2026 using terms related to AMS, altitude illness, athletes, exercise, mountaineering, acclimatization, prevention, Lake Louise Score, oxygen saturation, hydration and nutrition. English-language studies, reviews, consensus statements and guidelines were prioritized. WADA documents were consulted for doping issues.
Results. Rapid ascent, inadequate acclimatization, previous altitude illness, high early exercise intensity, individual oxygenation responses and poor symptom awareness are clinically important determinants of AMS risk. Fluid and energy imbalance may worsen exercise tolerance and complicate symptom interpretation, but they are not substitutes for acclimatization. The 2018 Lake Louise AMS Score is a practical field tool, whereas SpO2 and heart rate are supportive parameters only.
Conclusions. High physical fitness does not eliminate AMS risk. Preparation should combine gradual ascent, low training load during the first 24-48 h, individualized risk assessment, adequate nutrition and hydration, and daily symptom monitoring. New headache with gastrointestinal symptoms, dizziness, unusual fatigue, ataxia, confusion or dyspnea at rest should prompt rest, cessation of ascent and, when indicated, descent or treatment.
References
Beidleman, B. A., Tighiouart, H., Schmid, C. H., Fulco, C. S., & Muza, S. R. (2013). Predictive models of acute mountain sickness after rapid ascent to various altitudes. Medicine & Science in Sports & Exercise, 45(4), 792-800. DOI: https://doi.org/10.1249/MSS.0b013e31827989ec. PubMed: https://pubmed.ncbi.nlm.nih.gov/23135373/.
Bonato, G., Goodman, S. P. J., & Lathlean, T. (2023). Physiological and performance effects of live high train low altitude training for elite endurance athletes: A narrative review. Current Research in Physiology, 6, 100113. DOI: https://doi.org/10.1016/j.crphys.2023.100113. PubMed: https://pubmed.ncbi.nlm.nih.gov/38107789/. PubMed Central: https://pmc.ncbi.nlm.nih.gov/articles/PMC10724230/.
Burtscher, M., Hefti, U., & Pichler Hefti, J. (2021). High-altitude illnesses: Old stories and new insights into the pathophysiology, treatment and prevention. Sports Medicine and Health Science, 3(2), 59-69. DOI: https://doi.org/10.1016/j.smhs.2021.04.001. PubMed: https://pubmed.ncbi.nlm.nih.gov/35782163/. PubMed Central: https://pmc.ncbi.nlm.nih.gov/articles/PMC9219347/.
Cobb, A. B., Levett, D. Z. H., Mitchell, K., et al. (2021). Physiological responses during ascent to high altitude and the incidence of acute mountain sickness. Physiological Reports, 9(7), e14809. DOI: https://doi.org/10.14814/phy2.14809. PubMed: https://pubmed.ncbi.nlm.nih.gov/33904650/. PubMed Central: https://pmc.ncbi.nlm.nih.gov/articles/PMC8077104/.
Deng, L., Liu, Y., Chen, B., Hou, J., Liu, A., & Yuan, X. (2025). Impact of altitude training on athletes' aerobic capacity: A systematic review and meta-analysis. Life, 15(2), 305. DOI: https://doi.org/10.3390/life15020305. PubMed:https://pubmed.ncbi.nlm.nih.gov/40003714/.
PubMed Central:https://pmc.ncbi.nlm.nih.gov/articles/PMC11857729/.
DeWeber, K., & Scorza, K. (2010). Return to activity at altitude after high-altitude illness. Sports Health, 2(4), 291-300. DOI: https://doi.org/10.1177/1941738110373065. PubMed: https://pubmed.ncbi.nlm.nih.gov/23015950/. PubMed Central: https://pmc.ncbi.nlm.nih.gov/articles/PMC3445095/.
Gatterer, H., Wille, M., Faulhaber, M., Lukaski, H., Melmer, A., & Ebenbichler, C. (2013). Association between body water status and acute mountain sickness. PLoS ONE, 8(8), e73185. DOI: https://doi.org/10.1371/journal.pone.0073185. PubMed: https://pubmed.ncbi.nlm.nih.gov/24013267/. PubMed Central: https://pmc.ncbi.nlm.nih.gov/articles/PMC3754926/.
Hsu, T. Y., Weng, Y. M., Chiu, Y. H., Li, W. C., Chen, P. Y., Wang, S. H., Huang, K. F., & Chien, C. Y. (2015). Rate of ascent and acute mountain sickness at high altitude. Clinical Journal of Sport Medicine, 25(2), 95-104. DOI: https://doi.org/10.1097/JSM.0000000000000098. PubMed: https://pubmed.ncbi.nlm.nih.gov/24751723/.
Jia, N., Chen, C., Chen, Q., Liu, J., Shen, Z., Liu, Y., Pei, C., Wang, Y., Huang, D., Wang, F., He, Y., & Wang, Z. (2026). Acute high-altitude illness: Risk factors, susceptibility prediction, and personalized prevention and treatment. Frontiers in Medicine, 12, 1735083. DOI: https://doi.org/10.3389/fmed.2025.1735083. PubMed: https://pubmed.ncbi.nlm.nih.gov/41601827/. PubMed Central: https://pmc.ncbi.nlm.nih.gov/articles/PMC12832471/.
Karpęcka-Gałka, E., & Frączek, B. (2024). Nutrition, hydration and supplementation considerations for mountaineers in high-altitude conditions: A narrative review. Frontiers in Sports and Active Living, 6, 1435494. DOI: https://doi.org/10.3389/fspor.2024.1435494. PubMed: https://pubmed.ncbi.nlm.nih.gov/39584049/. PubMed Central: https://pmc.ncbi.nlm.nih.gov/articles/PMC11582915/.
Khodaee, M., Grothe, H. L., Seyfert, J. H., & VanBaak, K. (2016). Athletes at high altitude. Sports Health, 8(2), 126-132. DOI: https://doi.org/10.1177/1941738116630948. PubMed: https://pubmed.ncbi.nlm.nih.gov/26863894/. PubMed Central: https://pmc.ncbi.nlm.nih.gov/articles/PMC4789936/.
Lawrence, J. S., & Reid, S. A. (2016). Risk determinants of acute mountain sickness and summit success on a 6-day ascent of Mount Kilimanjaro (5895 m). Wilderness & Environmental Medicine, 27(1), 78-84. DOI: https://doi.org/10.1016/j.wem.2015.11.011. PubMed: https://pubmed.ncbi.nlm.nih.gov/26948557/.
Luks, A. M. (2012). Clinician's corner: What do we know about safe ascent rates at high altitude? High Altitude Medicine & Biology, 13(3), 147-152. DOI: https://doi.org/10.1089/ham.2012.1055. PubMed: https://pubmed.ncbi.nlm.nih.gov/22994513/.
Luks, A. M., Beidleman, B. A., Freer, L., Grissom, C. K., Keyes, L. E., McIntosh, S. E., Rodway, G. W., Schoene, R. B., Zafren, K., & Hackett, P. H. (2024). Wilderness Medical Society Clinical Practice Guidelines for the prevention, diagnosis, and treatment of acute altitude illness: 2024 update. Wilderness & Environmental Medicine, 35(1_suppl), 2S-19S. DOI: https://doi.org/10.1016/j.wem.2023.05.013. PubMed: https://pubmed.ncbi.nlm.nih.gov/37833187/.
Luks, A. M., Swenson, E. R., & Bärtsch, P. (2017). Acute high-altitude sickness. European Respiratory Review, 26(143),160096. DOI: https://doi.org/10.1183/16000617.0096-2016.
PubMed: https://pubmed.ncbi.nlm.nih.gov/28143879/.
PubMed Central: https://pmc.ncbi.nlm.nih.gov/articles/PMC9488514/.
Meier, D., Collet, T. H., Locatelli, I., Cornuz, J., Kayser, B., Simel, D. L., & Sartori, C. (2017). Does this patient have acute mountain sickness? The Rational Clinical Examination systematic review. JAMA, 318(18), 1810-1819. DOI: https://doi.org/10.1001/jama.2017.16192. PubMed: https://pubmed.ncbi.nlm.nih.gov/29136449/.
Nerin, M. A., Palop, J., Montaño, J. A., Morandeira, J. R., & Vázquez, M. (2006). Acute mountain sickness: Influence of fluid intake. Wilderness & Environmental Medicine, 17(4), 215-220. DOI: https://doi.org/10.1580/1080-6032(2006)17[215:AMSIOF]2.0.CO;2.
PubMed: https://pubmed.ncbi.nlm.nih.gov/17219784/.
Roach, R. C., Hackett, P. H., Oelz, O., Bärtsch, P., Luks, A. M., MacInnis, M. J., Baillie, J. K., & Lake Louise AMS Score Consensus Committee. (2018). The 2018 Lake Louise Acute Mountain Sickness Score. High Altitude Medicine & Biology, 19(1), 4-6. DOI: https://doi.org/10.1089/ham.2017.0164. PubMed: https://pubmed.ncbi.nlm.nih.gov/29583031/. PubMed Central: https://pmc.ncbi.nlm.nih.gov/articles/PMC6191821/.
Roach, R. C., Maes, D., Sandoval, D., Robergs, R. A., Icenogle, M., Hinghofer-Szalkay, H., Lium, D., & Loeppky, J. A. (2000). Exercise exacerbates acute mountain sickness at simulated high altitude. Journal of Applied Physiology, 88(2), 581-585. DOI: https://doi.org/10.1152/jappl.2000.88.2.581.
PubMed: https://pubmed.ncbi.nlm.nih.gov/10658026/.
Sareban, M., Schiefer, L. M., Macholz, F., Schäfer, L., Zangl, Q., Inama, F., Reich, B., Mayr, B., Schmidt, P., Hartl, A. J., Bärtsch, P., Niebauer, J., Treff, G., & Berger, M. M. (2020). Endurance athletes are at increased risk for early acute mountain sickness at 3450 m. Medicine & Science in Sports & Exercise, 52(5), 1109-1115. DOI: https://doi.org/10.1249/MSS.0000000000002232. PubMed: https://pubmed.ncbi.nlm.nih.gov/31876668/.
Shen, T. C., Lin, M. C., Lin, C. L., Lin, W. H., & Chuang, B. K. (2024). Acute mountain sickness on Jade Mountain: Results from the real-world practice (2018-2019). Journal of the Formosan Medical Association, 123(11), 1161-1166. DOI: https://doi.org/10.1016/j.jfma.2024.01.030. PubMed: https://pubmed.ncbi.nlm.nih.gov/38331638/.
Shen, Y., Yang, Y. Q., Liu, C., Yang, J., Zhang, J. H., Jin, J., Tan, H., Yuan, F. Z., Ke, J. B., He, C. Y., Zhang, L. P., Zhang, C., Yu, J., & Huang, L. (2020). Association between physiological responses after exercise at low altitude and acute mountain sickness upon ascent is sex-dependent. Military Medical Research, 7(1), 53. DOI: https://doi.org/10.1186/s40779-020-00283-3. PubMed: https://pubmed.ncbi.nlm.nih.gov/33148321/.
Viscor, G., Corominas, J., & Carceller, A. (2023). Nutrition and hydration for high-altitude alpinism: A narrative review. International Journal of Environmental Research and Public Health, 20(4), 3186. DOI: https://doi.org/10.3390/ijerph20043186. PubMed: https://pubmed.ncbi.nlm.nih.gov/36833880/. PubMed Central: https://pmc.ncbi.nlm.nih.gov/articles/PMC9965509/.
Wang, B., Chen, S., Song, J., Huang, D., & Xiao, G. (2024). Recent advances in predicting acute mountain sickness: From multidimensional cohort studies to cutting-edge model applications. Frontiers in Physiology, 15, 1397280. DOI: https://doi.org/10.3389/fphys.2024.1397280. PubMed: https://pubmed.ncbi.nlm.nih.gov/38978820/. PubMed Central: https://pmc.ncbi.nlm.nih.gov/articles/PMC11228308/.
World Anti-Doping Agency. (2026a). The 2026 Prohibited List: International Standard. https://www.wada-ama.org/sites/default/files/2025-09/2026list_en_final_clean_september_2025.pdf.
World Anti-Doping Agency. (2026b). TUE Physician Guidelines: Acute Mountain Sickness. Version 1.0, January 2026. https://www.wada-ama.org/sites/default/files/2025-12/tue_physician_guideline_-_acute_mountain_sickness_-_version_1.0_january_2026.pdf.
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Copyright (c) 2026 Kacper Częczek, Karolina Cieślewicz, Barbara Braksal, Bartosz Minik, Kinga Szymańska- Zdyb, Patrycja Nowaczek, Krzysztof Mirkowski, Zuzanna Wanda Szurek, Zofia Julia Chyła, Adam Miroński
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